Gun violence in America is a cancer—a metastasis that must be eradicated. As a nation, we continually mourn an ever-rising toll of victims and question why this senseless, tragic loss of life is repeated year after year. What is the reason for the increasing frequency of mass shootings? How is it that we are unable to stem the spread of this plague of gun-related deaths? When will we put an end to the massacres?

All good questions. And they have once again become the hue and cry of many people in the wake of the shooting at Marjory Stoneman Douglas High School in Parkland, Florida. This particular tragedy marked the 30th mass shooting in 2018—in other words, the latest in a line of tragedies that “should have” been preventable.1

Whatever your political stance on the issue of guns, surely we can all agree that it is a problem that more than 549,000 acts of gun violence occur each year.2 In 2015 (the most recent year for which a National Vital Statistics Report is available), there were 36,252 firearm-related deaths in the US—a rate of 11.1 deaths per 100,000 population. From 2012 to 2014, nearly 1,300 children died each year from a firearm-related injury.3 These statistics support the need to change our thinking about guns and gun violence.

Thus far, the discussion about gun control has tended to focus on passing and enforcing laws. We know that the US, compared to other countries, has fairly lenient restrictions for who can buy a gun and what kinds of guns can be purchased.4 In fact, many Americans can buy a gun in less than an hour, while in some countries, the process takes months.4 Furthermore, across the nation, there is no systematic fashion of gun regulation or ownership.

The challenge of how to balance gun safety and gun rights is an ongoing, yet one-focus, approach. The debate needs to be broadened; it’s time we stop talking about just the gun. We need to address the problem of firearm injuries in the context of a public health issue.5

A common assumption is that mental illness or high stress levels trigger gun violence. According to data from the Sandy Hook Promise organization, most criminal gun violence is committed by individuals who lack mental wellness (ie, coping skills, anger management, and other social/emotional skills).6 But other statistics contradict that notion. For example, a 2011 report in The Atlantic did not support mental illness as a causative factor in gun violence.7 And evidence presented by the Consortium for Risk-Based Firearm Policy indicates that the majority of people with mental illness do not engage in violence against others.8 The Consortium noted, however, that a small group of individuals with serious mental illness does have a propensity toward violence. It is this—the risk for dangerous behavior, rather than mental illness alone—that must be the focus for preventing gun violence.

Dangerous behaviors are those that carry a high risk for harm or injury to oneself or others.9 Emotional problems, social conflicts, access to weapons, and altered states of mind (via alcohol and drugs) all contribute to violent and homicidal behavior in adolescents.10 A worrisome fact: A nationwide study of mass shootings from 2009 to 2016 revealed that in at least 42% of these incidents there was documentation that the attacker exhibited dangerous warning signs before the shooting.11 So, in many cases of violent behavior, the perpetrator threatens others or his own life before actually carrying out his plan.12 But surely we must be able to do more than sit and watch for warning signs.